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Updated: Jan 7, 2026
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Complication Profiles of Immediate Implant-Based versus Deep Inferior Epigastric Perforator Flap Breast
Jina Kim1, Chanwoo Park1, Byung Joon Jeon1
1Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Purpose:
Immediate postmastectomy breast reconstruction in patients with history of breast-conserving surgery and radiotherapy presents unique challenges owing to previous surgical and radiation effects. This study evaluated the outcomes of implant-based and deep inferior epigastric perforator (DIEP) flap breast reconstruction in these patients.
Patients And Methods:
Patients who underwent total mastectomy followed by immediate implant-based or DIEP flap breast reconstruction between 2010 and 2023 with history of breast-conserving surgery and radiotherapy were reviewed. Major complications, including infection, skin flap complications requiring surgical revision, and reconstruction failure, were compared using univariate and multivariate logistic regression.
Results:
Among the 4306 immediate reconstructions, 105 cases met the inclusion criteria (70 implant-based and 35 DIEP flap reconstructions). The mean follow-up duration was 17.5 months in the implant-based group and 26.9 months in the DIEP group. Reconstruction failure occurred in 15.7% of the implant-based group and 0% of the DIEP group (p = 0.015). Major complications were significantly more frequent in the implant-based group than in the DIEP group (24.3% vs. 5.7%, p = 0.020). Multivariate analysis revealed that implant-based reconstruction carried 8.0-fold higher risk of major complications than DIEP reconstruction (p = 0.010). Skin-sparing mastectomy was associated with a significantly higher risk of complications than nipple-sparing mastectomy (odds ratio [OR] = 4.6, p = 0.010).
Conclusions:
In patients with prior breast-conserving surgery and radiotherapy, choosing a DIEP flap as a breast reconstruction modality may reduce complication risk compared with implant-based methods. These findings provide valuable guidance for preoperative patient counseling and surgical planning.
